Provider Demographics
NPI:1790795284
Name:DOUBLE ACE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:DOUBLE ACE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHONA
Authorized Official - Middle Name:PROBADORA
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-946-3577
Mailing Address - Street 1:600 N MOUNTAIN AVE STE B205
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4366
Mailing Address - Country:US
Mailing Address - Phone:909-946-3577
Mailing Address - Fax:
Practice Address - Street 1:600 N MOUNTAIN AVE STE B205
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4366
Practice Address - Country:US
Practice Address - Phone:909-946-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2400879251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2506037Medicaid
CA058328Medicare ID - Type UnspecifiedPROVIDER NUMBER